Claims Processor 

Location: Tucson, AZ
Date Posted: 02-12-2018
Medical Claims Processor – Managed Care
Tucson, AZ
** This is a Full Time, Benefits Available, CONTRACT opportunity, expected to last several months, or longer! ** 
Claims Processor Job Summary:
  • The primary role of the Claims Processor is to provide support for data information needs in the medical management departments.
  • The Claims Processor is responsible for performing financial and operational analysis, and preparing reports for a variety of areas including claims, premiums, calculating medical loss ratio (MLR), and other quality data.
  • They will complete reporting and analysis related to claims and operations, identifying trends and opportunities for cost-effective quality improvement strategies.
  • Their focus is to analyze and resolve pending and denied encounters based on federal and state guidelines.
Claims Processor Background:
  • Requires an education level of at least a high school diploma or GED.
  • Prefer, but does not require, a Certified Health Data Analyst (CHDA) or similar.
  • At least 1 year of experience claims processing, medical billing, administrative, customer service, call center, or physician’s office or other office services experience.
  • Knowledge of health care delivery system, Medicaid/Medicare, related state programs, and dual eligibility programs preferred.
  • Established experience with database management system and basic familiarity with Medical terminology is required.
  • Working knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology preferred.
  • Computer skills, including the ability to learn new and complex computer system applications.

Associate Search Consultant
CareNational Healthcare Services
480.448.6498 (CALL – TEXT – FAX)
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